think one of the biggest problems with Heart
Failure is the name itself! HEART
FAILURE, before I started this job I assumed heart failure was acute and imminent, if you had heart failure surely you would have minutes left to live? your heart has failed.... I was wrong and mislead by the wording so lets put that to rest straight away!
In fact a fantastic Heart
Failure organisation called Pumping Marvellous
would like to see the condition renamed 'Heart Inefficiency'!
What is Heart Failure?
In a nutshell heart failure is when your heart is no longer healthy enough to pump enough blood to meet the bodies needs.
All parts of your bodies need nutrients delivered to them and byproducts taken away when this delivery service and trash collection starts to slow, different parts of the body can not work efficiently.
This can lead to symptoms such as:-
Dyspnea (Shortness of Breath)
Extreme Tiredness and Weakness
Lack of Appetite
Confusion or Difficulties in Concentrating
Two Main Types of Heart Failure
Systolic = When the Bottom of the Heart is Contracting (Pumping)
Diastolic = When the Bottom of the Heart is Filling (Relaxing)
Ischaemic Heart Disease
Valvular Disease (disease of the hearts valve)
Connective Tissue Disease
The percentage of blood expelled by the Left Ventricle
with each heart beat is called the Ejection Fraction! If it is faulty, the Ejection Fraction is reduced... roughly half of people diagnosed with heart failure do not have a reduced Ejection Fraction i.e. the pumping function of the heart is not faulty! Instead it is the FILLING of the heart that is subnormal. This is called - HFPEF
Heart Failure with Preserved Ejection Fraction, whilst the causes and mechanisms involved in this form of heart failure it is generally accepted that a stiffening or an inability for the cardiac muscle to relax properly affects its pumping ability. There is more attention being given to myocardial fibrosis being the underlying pathology. In short, if the heart doesn't relax properly, the heart does not fill with as much blood and reduces Stoke Volume whilst Ionotropic differences (chemical that increases the force of contractions) further reduce the pumps efficiency. Again causes of HFPEF are lesser understood but Systolic Hypertension, Female Sex and Atrial Fibrillation
seem to show a causal link (the smoke where there is fire).
Failure of this nature is referred to as Diastolic Dysfunction.
NB - Left Ventricular Systolic Dysfunction is almost always accompanied by Left Ventricular Diastolic Dysfunction - When we mention medications later, the diuretic therapy is particularly pertinent to the LVDD.
Congestive Heart Failure
Congestive Heart Failure is where BECAUSE of this lack of pumping efficiency means that blood is not moving around the body smoothly, this causes an increase in pressure in the lungs and veins. The extra pressure means that the fluid in the blood can leak into surrounding tissue. This gives us two typical symptoms of Congestive Heart Failure. Fluid accumulation in the Lungs (Pulmonary Edema) leading to a cough that won't go away! and swollen arms and legs (Peripheral Edema).
Why Does the Fluid Leak out and Build Up in Other Tissue?
Remember fluid takes the path of least resistance... you turn on a hose pipe and fluid comes out the end, if you increase pressure at the end of that hose pipe (put a kink in it) then the water will start to drip out the connection to the tap. Fluid in the body behaves in the same way the heart failure is causing a 'KINK' in the circulatory system.
Severity of Heart Failure
Heart failure is a spectrum, like many illnesses. Asthma for example, some people are hampered by Asthma but live normal lives others have extremely bad Asthma which can put there life at risk.
One method to help healthcare professionals decide on the best treatment options for our heart failure patients we have a classification criteria as follows that was developed by the New York Heart Association.
Treatment of Heart Failure.
There are some reversible causes of Heart Failure - Treatment of these therefor will 'cure' the heart failure. These are - Infection, Alcohol Consumption (not to be confused with prolonged Alcohol abuse), Anaemia, Arrhythmia and hypertension. Treating these can lead to the heart re-modelling and returning to normal.
Invariably most Heart Failure is permanent and so the treatment focuses on reducing Symptoms and preventing the Heart Failure from progressing.
- Medication (I will break these down in future heart failure posts) - ACE Inhibitors, Oral Loop Diuretics, Beta Blockers, Angiotensin Receptor Blockers.
- Cardiac Resynchronisation Therapy (CRT) Biventricular Pacemaker are considered in patients whom would benefit from Ventricular Resynchronisation.
- In a select few, Cardiac Transplant is a treatment option.
- Exercise is encouraged as tolerated.
So there you have it, a very quick synopses of Heart Failure that is kicking off a section of the website that will be dedicated to raising awareness. Identifying heart failure early and treating it correctly will improve the prognosis for many, there are discrepancies in treatment of Heart Failure and I will be highlighting these in my next post on Heart Failure.